대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1167 Date 2020-03-09

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  • Courtesy of Mi Jung Park / Gyeongsang National University Hospital
  • Age/Sex 38 / M
  • Chief Complaintacute epigastric pain (for 1 week)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Esophageal duplication cyst with complication (intracystic hemorrhage)
Radiologic Findings
Chest PA shows well-defined, soft tissue mass in retrocardiac region and obliteration of azygoesophageal recess. Chest CT shows about 7.8x3.8cm sized, multiseptated cystic mass with thick wall in posterior mediastinum, abutting lower esophagus. There is no evidence of pneumomediastinum or fluid collection in chest CT.


Brief Review
Dark hemorrhagic fluid within cystic mass was seen in the operation field.

Mediastinal cystic masses are well-defined, round, epithelium-lined lesions that contain fluid on chest CT. The mediastinal cystic mass include bronchogenic cysts, esophageal duplication cysts, pericardial cysts, neurenteric cysts, meningocele, thymic cysts, cystic teratoma, and lymphangioma.
Most esophageal duplication cysts are diagnosed in childhood and while symptomatic cyst into adult life is very rare. Acute onset is generally due to complications such as intracystic hemorrhage, perforation, and infection, especially of the cyst with esophageal communication. Esophageal duplication cyst looks similar to that of bronchogenic cysts except that the wall of the lesion may be thicker and in more intimate contact with the esophagus on chest CT. Complete surgical excision is the treatment of choice.
Please refer to
Case 152, Case 552, Case 1037,
KSTR Symposium 1998  Case 9,
References
1) Differential Points of Mediastinal Cystic Lesion in Chest Computed Tomography J Korean Soc Radiol 2013;69(4):287-293
2) Imaging of Cystic Masses of the Mediastinum RadioGraphics 2002; 22:S79
Keywords
esophagus, esophageal duplication cyst,

No. of Applicants : 80

▶ Correct Answer : 14/80,  17.5%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - McGill , Canada ADRIANA SOFIA MORALES
  • - Chonnam National University Hwasun Hospital , Korea (South) INWOO CHOI
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Seoul Veterans Hospital , Korea (South) JANG SEONG WON
  • - Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
  • - Kitano Hospital , Japan SATOSHI IKEDA
  • - Chonnam National University Hwasun Hospital , Korea (South) PARK HYE MI
  • - , Korea (South) SONG MYUNG WON
  • - , Japan YUMI MAEHARA
▶ Correct Answer as Differential Diagnosis : 23/80,  28.8%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - McGill University Health Center , Canada Alexandre Semionov
  • - , Korea (South) CHOHEE KIM
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - St. Lukes International Hospital , Japan DAISUKE YAMADA
  • - , Korea (South) JIN YOUNG LEE
  • - , Jordan HISHAM IBRAHIM KHATIB
  • - Soonchunhyang University Hospital Bucheon , Korea (South) SEONGHWAN BYUN
  • - Seoul Veterans Hospital , Korea (South) JI HOON NOH
  • - , Japan NAOMI YUASA
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , India SUSHANT JOSHI
  • - , Japan KAZUMA TERAUCHI
  • - Private sector , Greece VASILIOS TZILAS
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - liaquat national hospital , Pakistan ZUNAIRAH RAIS
▶ Semi-Correct Answer : 7/80,  8.8%
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Hallym University Dongtan Medical Center , Korea (South) MINSU KIM
  • - , Taiwan NING CHIEN
  • - Jiangsu province hospital , China WANGJIAN ZHA
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